MEDICARE: ERIC M WOLFSON D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036103109	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023044773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC M WOLFSON D.O.

Provider Business Mailing Address
First Line	:	10788 RIVENDELL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1803
Country	:	US
Telephone Number	:	702-566-5343
Fax Number	:	702-566-4549

Provider Business Practice Location Address
First Line	:	6803 W TROPICANA AVE
Second Line	:	STE #100
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4926
Country	:	US
Telephone Number	:	702-452-2525
Fax Number	:	702-452-2534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	11/26/2007

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